Individual
MALYSSA EMILY CHANTHASOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 CROMWELL AVE STE 404, ROCKY HILL, CT 06067-3455
(860) 525-4469
Mailing address
1111 CROMWELL AVE STE 404, ROCKY HILL, CT 06067-3455
(551) 427-7163
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-15498
NC
363A00000X
Physician Assistant
5241
CT
Other
Enumeration date
06/17/2021
Last updated
11/05/2025
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